1. Field of the Invention
The present invention relates to surgical procedures, and particularly to transoral repair of choanal atresia.
2. Description of the Related Art
Choanal atresia is a congenital obstruction of the back of the nose (posterior choanae) that prevents communication between the nose and nasopharynx. The incidence is around 1 in every 5,000 births. It results from failure of canalization of the posterior choanae. When the atresia is bilateral, it presents a life-threatening situation that has to be dealt with in the early days of life.
Traditionally, repair of choanal atresia was done blindly using puncture dilators through the nose. This technique was first described by Emmert in 1854. Recurrence rates were high and required multiple dilation to achieve patency.
Subsequently, repair was done via the transpalatal approach. This approach involves incising the soft palate to reach the posterior choanae. This approach was successful and showed lower recurrence rates, but unfortunately had more complications. Complications of this approach include wound dehiscence, fistula formation, and interruption of palatal growth. These complications lead to dentition problems and cross-bite deformity in children.
With the advent of endoscopic techniques, surgeons used small endoscopes to reach the posterior choanae transnasally. This transnasal approach became more popular and almost replaced the transpalatal approach. Recurrence of choanal atresia after transnasal approach is more common than the old transpalatal approach, but due to fewer complications, surgeons have stuck with the least invasive technique. Recurrence has been shown to be more common if the endoscopic procedure was done in the neonatal period (first 30 days of life). The reason for recurrence is thought to be due to the young age of neonates, and possibly also due to intrinsic factors that led to the stenosis in the first place playing a role in re-stenosis.
The present inventor believes that recurrence in the neonatal period is due to difficult access and incomplete removal of the atretic plate (stenosis), rather than the young age of children. In addition, neonates have small nasal passages, and the transnasal approach might be difficult, especially if endoscopic shaver or drilling of lateral pterygoid plates is required. Associated nasal abnormalities, such as mid-nasal stenosis, make the transnasal approach even more difficult.
Therefore, transoral repair of choanal atresia solving the aforementioned problems is desired.